3/22/2018
在平静了一年半后，癌细胞又开始活跃了。
一个月前PET显示左肺内原发灶suv上升，右跨关节前下方软组织条柱状增生，高摄入值，提示可能新转移灶。
二周前CEA11.2，A医生将我的病情在每周肿瘤会诊时与相关同行讨论。认为可能复发，有新转移灶；也可能有肠道癌变。
安排了一糸列会诊寻求解决方案。在本周一，见了肿瘤外科医生。周二见了放疗医生。
並约了一糸列检查。今天（3/22/2019，周四）上午十点做右跨关节周软组织活检，下午二点胸腔穿刺。下周做肠镜。
7:50AM 离家。
8:10AM 到办公室，启动数据更新程序，发送前日临床检查异常数据报告给各临床医生。
8:30AM 赶到外科手术候诊大厅，签到，糸上腕标，签了需知和Consent。等号
9:05AM 还在等叫号。经历过二年半的诊治休养，我们也有充分的心理准备，能够坦然面对。大厅里的其他病人家属亲友也少有焦虑不安的。
10:00AM 被带手术室外，等。
10:05AM 进入准备室。换上被手术的袍子，扎了静脉针，与助理医生讨论了将要做什么及细节，签了手术协议书，在移动床上躺着，等待。
将要进行：镇静剂加局部麻醉，CT指导下针穿取样。
自昨晚上七点后，食水未进，快要饿晕了。
10:30AM 仍在等待, 也许是最无奈的选择。
11:00AM 等，刚才已小睡一会
11:10AM 护士敲门通知：前面那个延迟，请等待……
在看网络小说“相声大师”，顺便学学练练，争取来年春节再当回网上段子手
11:30AM 终于进了手术室，打了镇静剂，加了鼻管。在反复扫描定位后，局麻，穿针，再次定位。终于穿到地方。最后再扫描确认，接下来，取了三小块样品。
12:15PM 回到观察室，继续监控血压心率血氧饱和度。
1:15PM 观察1小时后，给了注意事项和联系电话。换衣。叫来社工用轮椅送到做胸穿的科室
1:25PM 鉴到，被告之不能进食，继续饥饿中，等待。
1:45PM被带入诊室，再次测血压量体温，还有：等待。
2:10 換手术装，再次签免责。
2:15 超声探查，医生惊呼：好多水啊。局麻，进针，没有液体流出，再进，仍无液体，换个方向再进，仍抽不出来，医生放弃了
2:45PM 离开处置室，回家。以后再和A医生商量换个胸外科医生。
3:20到家，先嚼两片全麦面包，微波炉热粥，饿得不行了
3:40PM 要休息睡一会。
今天碰到两个医生，跨骨穿刺的那位真正有水平。新发病灶在关节周围，位置深，附近布满动静神经，肌腱。术前讨论时，反复查看所有CT、PET和X-ray, 寻找最佳进针角度深度。术中反复用CT定位五次，确认无误，取样。术后两小时，与平时感觉无异。
另一位，实在不敢恭维，连个胸水都抽不出来，也配干胸外。再次想念当初的B医生，业务熟练，为人谦和。给我抽了三次胸水，一次气管镜检和一次胸腔镜检。第一次抽时还没开始其它检查，我俩私聊，他根据胸水，笃定“非小细胞肺癌”。可惜不在这工作了。
附：病理报告
Case Report
| Clinical Information | |||
| 61 year old male with history of stage-4 adenocarcinoma of the lung, presents with soft tissue mass of right hip. | |||
| FINAL DIAGNOSIS | |||
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A. Soft tissue, right hip, IR guided biopsy:
- Low grade fibroblastic proliferation; see comment.
- Negative for carcinoma.
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| Amendment electronically signed by Matthew R. Lindberg, MD on 4/11/2018 at 1:12 PM Electronically signed by Matthew R. Lindberg, MD on 3/27/2018 at 1:48 PM |
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| Comment | |||
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By immuonhistochemistry, the lesional cells are focally positive for SMA, and negative for desmin, S100 protein, pankeratin, and nuclear beta-catenin. Overt histologic features of malignancy are not identified. Mitotic activity is sparse, and there is no necrosis. The differential diagnosis includes predominantly fibromatosis, fasciitis, and low grade myofibroblastic sarcoma.
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| Gross Description | |||
| Specimen A is received in formalin, labeled with the patient's name, Gonghe Dai, medical record number, 001051883, and RIGHT HIP BX. The specimen consists of four cores of tan tissue measuring 2.5, 2.4, 0.6 and 0.2 cm in aggregate. Specimen A is submitted entirely in a biopsy bag inside a yellow biopsy cassette A1. Brandeon A. Harris 03/22/2018 |
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| Microscopic Description | |||
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Performed if applicable.
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| Attestation | |||
| Matthew R. Lindberg, MD Electronically Signed on 3/27/2018, 1:48 PM I have reviewed the pertinent gross findings, any and all microscopic slides and the Resident's/ Fellow's interpretations. I have made appropriate editorial changes and have rendered the final diagnosis. |
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| SPECIAL AND ADDITIONAL PROCEDURES | |||
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Analytic Specific Reagents were developed with performance characteristics determined by UAMS Immunohistochemistry Lab. It has not been cleared or approved by the U.S. Food and Drug Administration. The FDA has determined that such clearance or approval is not necessary. When used, this test is used for clinical purposes. It should not be regarded as investigational or for research. Controls are routinely performed on all Analytic Specific Reagents and are verified for acceptability. This Laboratory is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA-88) as qualified to perform high complexity clinical laboratory testing.
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